The consumer protections under the Affordable Care Act also apply to student health plans, with several adjustments due to the unique nature of these plans:

Annual limits. Like other health plans, student plans cannot put annual dollar limits on coverage of “essential health benefits.” That does not mean that your plan has no limits — it just can’t limit coverage of “essential health benefits.” These include services in ten essential areas, including outpatient care; emergency room visits; inpatient care; pre- and post-natal care; mental health and substance use disorder services; prescription drugs; rehabilitation services and devices, including physical and occupational therapy and more; lab tests; preventive services; and pediatric services, including dental and vision care for children under the age of 18.

Self-funded plans (or plans funded by an institution such as a university, rather than an insurer) typically do not have to meet the requirements of the ACA. Therefore, the annual loss limit and a few other rules do not apply to self-funded student health plans.

Covering your college-bound child under your existing policy could prove the simplest and most cost-effective way to provide quality coverage. The ACA requires health insurance policies to allow children to stay on a parent’s plan until they turn 26 years old, regardless of their marital or student status.

If your child is going out of state, check your plan’s list of network providers to see whether it includes any near your child’s college. Many PPO and HMO plans cover services from non-network healthcare providers, but at significantly lower percentages. This could greatly increase your out-of-pocket costs.

Some families buy student health insurance and keep their child on the family plan. When you have more than one applicable insurance policy, “coordination of benefits” rules decide which one pays first.

We can help you evaluate health insurance options for all your family members. Please contact us for information.